With extreme thrills come some equally extreme perils

Despite several well-publicized accidents, like the death last year of snowmobiler Caleb Moore, just 25, the popularity of extreme sports has soared in recent years. Participants in the X Games and other sporting events regularly perform heart-stopping tricks on skis and snowboards, skateboards and mountain bikes, all of them endlessly replayed on YouTube and television for a growing audience of thrill-seekers.

Unfortunately, many young people eager for an adrenaline rush are trying to copy their extreme sports idols, putting themselves at terrible risk.

(Illustartioin / Ellen Weinstein for The New York Times)

Filled with overconfidence, many participants lack the skills and training for these stunts. And often they fail to use safety equipment that could reduce the risk of serious injury. Amateurs without referees, coaches or medical personnel around can end up with broken bones, crushed skulls, severe concussions, ruptured blood vessels or lifelong disability -- if they survive.

More than 4 million injuries attributed to extreme sports occurred from 2000 through 2011, according to data collected by the National Electronic Injury Surveillance System. In the first-ever study of the nature of these injuries, Dr. Vani J. Sabesan, an orthopedic surgeon at Western Michigan University School of Medicine, and her colleagues examined the incidence of head and neck injuries, the most serious hazards short of death.

At the recent annual meeting of the American Association of Orthopedic Surgeons, Sabesan reported that more than 40,000 such injuries occur annually among participants in seven extreme sports, including skateboarding, snowboarding, mountain biking and motocross.

Her analysis showed that 83 percent were head injuries and 17 percent neck injuries, with 2.5 percent described as severe, resulting in potential lifelong disability or death.

"The level of competition and injuries we're seeing keep rising," Sabesan said. "Many do recover, but not necessarily without long-term consequences."

Sabesan noted that head and neck injuries were of particular concern because of the "increased awareness of their short- and long-term consequences: concussions, fractures and traumatic brain injuries, which can result in outcomes such as chronic depression, headaches, paralysis and death."

Skateboarding caused the most head and neck injuries: more than 129,000 reported during the study's 12 years. Snowboarding produced more than 97,000 such injuries, while skiers experienced more than 83,000, and motocross participants more than 78,000.

Sabesan said that not only were more people engaged in extreme sports each year, but also that the participants were younger.

"With very young kids tearing down ski slopes at 60 miles an hour, the risk of suffering a life-changing injury is all too real," she said.

"Young people often lack judgment," she added. "They see snowboarder Shaun White take the sport to a whole new level, and some kids try to emulate his tricks. In effect, the culture says it's OK to try this."

According to Sabesan, skateboarding is particularly hazardous because helmets, now routine for skiers, are not required. Yet, she said, "when you land on your head on concrete or asphalt, it's not as forgiving as snow." The study found the risk of suffering a skull fracture while skateboarding was 54 times that of doing so while snowboarding.

Her first recommendation to reduce the risk of serious injury is to use proper safety equipment. "A simple thing like wearing a helmet can go a long way toward preventing a lifelong disability," she said.

Her own experience underscores this advice. While training for a triathlon, she flipped over the handlebars of her bike and landed on her head. A helmet protected her brain.

My 23-year-old nephew, Sam, was spared permanent disability by the protective garments he wore during a terrifying fall while biking on a mountain trail two summers ago.

Coming very fast downhill into a blind turn, he said, he was able to hop over two logs across the trail, but his front wheel caught the third log and he was catapulted over the handlebars. He landed on his head hard enough to split his helmet. He was knocked unconscious and badly banged up, but no bones were broken and his brain recovered fully.

"I was wearing a full-mask helmet and a full upper-body suit of armor called a pressure suit, as well as knee and shin guards," he said. The suit and guards protected a shoulder and knee that also landed hard, he said, but "if I hadn't been wearing that helmet, I probably wouldn't be here."

Even after suffering serious injuries, extreme sports participants often come back for more. Sabesan said she recently treated a 28-year-old woman for a broken arm and two fractured femurs suffered while she attempted a jump at an all-terrain-vehicle racetrack in Michigan. The woman, who works as a bank manager, had previously suffered a broken neck and ribs in a similar accident.

"The occurrence of serious injuries is definitely increasing as participation rates in extreme sports go up," Sabesan said. Yet, she added, adequate studies of the associated risks have not been done.

"We have no baseline," she said. "No one is monitoring injuries that occur during the X Games. There's minimal literature on hip and knee dislocations, broken bones or the long-term effects of head and other injuries."

Sabesan said her findings pointed to the need for trained supervision and medical assistance at extreme sports events, as well as proper training of participants and mandated safety equipment.

Jane Brody

Jane Brody reports on health for the New York Times.

Last modified: April 8, 2014
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